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Identifier 000431604
Title Μυοκαρδίτιδες στην παιδική και νεανική ηλικία : Επιδημιολογικά δεδομένα και προγνωστικοί δείκτες
Alternative Title Myocarditis in childhood and young age
Author Μαγούλιου, Θεονύμφη
Thesis advisor Μπριασούλης, Γεώργιος
Reviewer Ηλία, Σταυρούλα
Παρθενάκης, Φραγκίσκος
Abstract Background Myocarditis is an inflammatory disease of the myocardium, mainly of viral etiology, with a higher incidence in male infants and adolescents. Signs and symptoms of myocarditis vary from mild to life-threatening. It is characterized by high levels of troponin and and by specific findings on the electrocardiogram and echocardiogram. Cardiovascular magnetic resonance imaging and endomyocardial biopsy are considered diagnostic methods of choice. The prognosis of myocarditis is usually good with a higher probability of complications in newborns and infants in the early stages of the disease. Decreased left ventricular ejection fraction and high troponin levels are considered to be the main poor prognostic factors. Objective The aim of this study is to record relevant epidemiological indicators of myocarditis in the region of Crete and to associate demographic and clinical -laboratory data with complications and disease outcome indicators. Also, a second purpose of the study is to investigate the contemporary diagnostic methods of pediatric and juvenile myocarditis and their contribution to the diagnosis and prognosis of the disease. Methods This is a retrospective monocentric study, in which the sample included children, adolescents and adults up to 32 years of age who were treated in the Pediatric Intensive Care Unit (PICU) and the Cardiology Clinic of the University General Hospital of Heraklion from 2008 to 2020 with the final diagnosis of myocarditis. Data collection was done from electronic and printed patient files and included a variety of variables for each patient. The statistical method included frequencies, descriptive statistics, Pearson correlation, Chi-squared test, analysis of variance (ANOVA), regressions and statistical analysis was performed with the SPSS program. Results Eighty-seven percent of 76 patients were male with a mean age of 19 years and the main symptom was chest pain with concomitant symptoms from the respiratory and gastrointestinal systems. High levels of troponin were recorded, especially in PICU patients and were statistically significant correlated with (p< 0.001) AST, LDH, CKMB, but not with BNP and duration of hospitalization. The AST (p = 0.002) and CKMB (p = 0.038) levels were independently related to the Tn-I levels of the day of admission. Eighty-two percent of all patients had a pathological finding on the electrocardiogram, with the most common being ST segment elevations and negative T waves. ST segment elevation (65%) and negative T waves (59%) were more common in PICU patients compared with patients in Cardiology Clinic (p = 0.015 and p = 0.025, respectively). Thirty-five percent of patients showed left ventricular contractility disorder on ultrasound and the left ventricular ejection fraction (LVEF) <40% was associated with increased white blood cells (WBC)(p <0.001), decreased left ventricular wall mobility (p = 0.001) and negative disease outcome. In seventy-five percent of patients who had a CMR, the test was positive for myocarditis. Viral control showed that rhinovirus and enterovirus were the most common causes of myocarditis. Younger patients hospitalized in PICU, were more likely to have EF <40% compared with adults in the cardiology clinic (p = 0.01). A negative outcome (deterioration or death) was better predicted by an EF <40% (p = 0.001) and an increased number of white blood cells (p = 0.002) on the day of admission. More patients from the Cardiology Clinic improved compared to PICU patients (98% vs. 79%, p = 0.012) and they showed a lower complication rate (3.6% vs. 21.1%, p = 0.015). Conclusion Pediatric ICU patients have a more severe form of myocarditis than yound adult patients of Cardiology Clinic, with higher troponin values and higher rates of reduced contractility and left ventricular wall mobility disorder, ST segment elevations and negative T waves. Rhinovirus and enterovirus are the most common viral causes of myocarditis, and CMR is proved to be of high diagnostic value. Although acute myocarditis outcome is negatively affected by young age, initially increased number of white blood cells and LVEF < 40%, its prognosis remains good in the majority of patients.
Language Greek
Subject Epidemiology
Issue date 2020-08-05
Collection   Faculty/Department--School of Medicine--Department of Medicine--Post-graduate theses
  Type of Work--Post-graduate theses
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